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Stellate-Cell Lipidosis in Liver Biopsy Specimens
Recognition and Significance

Pascale Hummel Levine MD, Yara Delgado MD, Neil D. Theise MD, A. Brian West MD
DOI: http://dx.doi.org/10.1309/6DKC03C4GAAEN2DK 254-258 First published online: 1 February 2003

Abstract

Hepatic stellate-cell lipidosis due to hypervitaminosis A can lead to cirrhosis, which can be averted by restricting vitamin A intake. Other causes, including the use of synthetic retinoids, have been postulated. We studied the frequency and etiology of stellate-cell lipidosis in patients undergoing liver biopsy for reasons other than vitamin A abuse. Fourteen cases (1.1%) were identified retrospectively among 1,235 nontransplant liver biopsy specimens examined from January 1995 through December 1999. Diagnostic criteria included the following: lipid-laden cells in the space of Disse; small, dark, crescent-shaped nuclei with inconspicuous nucleoli; and wispy cytoplasmic strands separating fat droplets. Patient details, reason for biopsy, and medication use were studied. Reasons for biopsy included hepatitis C (10 cases), abnormal liver enzyme levels (2 cases), methotrexate use (1 case), and alcohol abuse (1 case). Hypervitaminosis A was not suspected clinically in the 5 patients who used oral vitamin A or 3 who used topical tretinoin (Retin-A). In 6 patients, no cause of stellate-cell lipidosis was discerned. Stellate-cell lipidosis should be reported to alert clinicians to a potentially preventable form of liver injury.

Key Words:
  • Stellate cell
  • Ito cell
  • Fat-storing cell
  • Fibrosis
  • Liver
  • Vitamin A
  • Retinoids
  • Tretinoin (Retin-A)